ACQ Vol 12 No 2 2010

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72 ACQ Volume 12, Number 2 2010 ACQuiring knowledge in speech, language and hearing
already demanding schedules. If the situation is not
discussed and monitored closely, some parents may end up
feeling guilty and discouraged about the treatment process,
or worse, conceal the reality of their circumstances. Rather
than focusing on what the parent has not achieved, the SP
should attempt to build on what the parent has already
accomplished. For example, if a parent reports being able to
complete treatment for only 5 minutes per day, the SP may
suggest that an additional 2 minutes of treatment be applied
each week, until the recommended dose of treatment is
achieved. It is equally important to give parents the
opportunity to suggest their own solutions to any scheduling
problems. In doing so, parents may be more inclined to take
ownership of their ideas and follow through with the
solutions discussed. By setting parents up for success in this
way, the completion of treatment tasks should become a
more feasible part of their daily routine.
Problem 7
The child’s siblings distract the parent or child
during treatment.
Possible solution When one child receives parental
attention to the exclusion of siblings, as may occur during
stuttering treatment, it is almost inevitable that siblings will
attempt to disrupt the session. If not resolved, the situation
could result in an overall reduction of treatment quality or
duration. One potential solution to the problem is to allow all
children to participate in treatment. In doing so, the parent
can focus treatment on the child for whom it is intended
while also attending to the demands of other siblings.
Another solution may be to prepare, in advance, an alternate
activity for siblings to complete while stuttering treatment is
being delivered. For this to succeed, the activity must be
appealing enough to keep the siblings interest for the entire
treatment session. A reward system may need to be
developed to ensure that the alternative activity is sufficiently
engaging and motivating. In fact, if a reward system has
already been developed for the child receiving stuttering
treatment, it may be advantageous to apply a similar reward
system to the alternative activity so as to minimise sibling
dispute.
demonstrate great insight into the fluctuations of their child’s
stuttering each day and require only minimal training in the
task of collecting scores. Nevertheless, when initially
instructing parents to use a severity rating scale it is
important to calibrate readings between users, or risk the
scale becoming potentially meaningless. To do so, a sample
of the child’s speech within the clinic can be rated
independently by both the clinician and parent. Severity
scores can then be compared and discussed until they differ
by no more than 1-scale point. During the calibration stage,
it is important for clinicians to emphasise that the severity
scale does not require parents to count the actual number or
type of stutters present. Rather, scores should be a
subjective reflection of the child’s typical level of stuttering
each day. On the whole, provided that the clinician discusses
severity rating scores regularly, it is likely that parents will
continue collecting them consistently.
Problem 5
The parent has difficulty identifying stutters.
Possible solution Given that many preschool children
exhibit normal disfluency as they acquire language, it can be
difficult for parents to identify stuttered moments during the
day. Accordingly, parents can be instructed to consider only
unambiguous stuttering when attempting to assess severity
in this age group. Unambiguous stuttering refers to speech
behaviours that can be clearly and unequivocally categorised
as either repeated movements or fixed postures (see
Teesson, Packman, & Onslow, 2003). When uncertain, the
general rule should be to overlook ambiguous disfluencies.
Some parents, however, may need assistance in
distinguishing stuttering from normal disfluency. To do so, a
sample of the child’s speech within the clinic can be
assessed by the clinician, reporting back to the parent when
stuttering has occurred. With modelling and clear instruction,
it is likely that parents will learn to identify stuttering quickly
and accurately.
Problem 6
Parents are unable to schedule regular
treatment times.
Possible solution It is common for parents to feel
overwhelmed with the addition of treatment tasks to their
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